Aug
31
2013

Peanut Allergies Are Deadly

In the US 1.5 million suffer from peanut allergies (Ref.1). People who have peanut allergies have to avoid peanuts and foods that contain even traces of peanuts lifelong. Here is a recent example of a 13-year old girl who died at a camp when she tried food contaminated with peanuts. Before we discuss peanut allergies in detail, we need to review first how the immune system is functioning.

How the immune system is primed to develop an allergy

Our immune system knows the difference between our own body components and substances that come from the outside. Scientists call this tolerance to our own surface proteins; and scientists call it an immune reaction that is mounting as a reaction to anything different from the surface antigens. There are different cells that make up the immune system. One of the main working cells of the immune system are the lymphocytes, with B cells originating from the bone marrow producing antibodies when an immune reaction occurs. Antibodies fit like a lock and key to the surface of an antigen, in this case the peanut protein. T helper cells are T lymphocytes (thymus derived lymphocytes) that help the B cells to recognize the difference between the own protein components and the outside components. There are also T killer cells, which get activated when parasites or viruses enter the body. With regard to peanut allergies it is the B cells and T helper cells that interact and the B cells produce a powerful, very specific IgE antibody directed against peanut protein. There are memory B cells, which continue to produce these specific anti-peanut protein antibodies and cause severe allergic reactions when future exposure to peanuts (even traces) occurs. So, the more often a person who is allergic to peanuts encounters even traces of peanuts, the immune system will get boosted and produce even more antibodies of the IgE type through reactivated B memory cells (Ref. 2). 98% of the population does not react to peanut exposure with allergies, but the other 2% who may have genetic susceptibility factors that predispose them to this often develop life-threatening reactions (an anaphylactic reaction).

What is an anaphylactic reaction to peanuts?

The most extreme form of allergies involving IgE antibodies can cause anaphylaxis. In the beginning stages of a peanut allergy there may only mild symptoms such as hives on the skin, itching and tingling around the mouth, a runny nose, a scratchy throat, wheezing, stomach cramps, vomiting or diarrhea. However, with a more severe allergy an asthma attack can develop, blood pressure drops leading to fainting or shock and severe airway obstruction in the throat or lungs can cause suffocation.

I vividly remember an 11-year-old boy who was brought in by ambulance to the emergency room of the hospital where I was working as the on-call physician. He had a hard time talking as his throat was swelling up as part of his anaphylactic reaction, within minutes he passed out completely (shock). Fortunately an anesthetist was in the department and could intubate him very quickly. However, despite adrenaline treatment, oxygen  by artificial ventilation and high doses of corticosteroid drugs he did not wake up until 10 hours later. In retrospect it turned out that he had eaten some crackers of a familiar brand that he knew as being free of peanut flour. However, he had seen an ad that the same brand of crackers was available as cheese crackers and he tried one of these, which prompted his admission to the hospital. The parents read the ingredients later: the label on the cheese crackers noted in small print that the flour of the cheese crackers contained peanut flour! Always read labels, even if it is a familiar brand! Fortunately for this boy he did not have brain damage from the time of his unconsciousness. He has been extremely careful since and is reading labels and avoiding unknown food items.

Peanut Allergies Are Deadly

Peanut Allergies Are Deadly

Cross-reactions between peanuts and other allergens

Allergies can be made worse when a person has inhalant allergies from pollens of trees or grasses that can share protein components from protein found in foods. The latest findings are that there are cross allergies between Fenugreek and lupine, which are both legumes, as are peanuts, so there are common antigens present in their proteins. A mouse-testing model has shed more light on this. Fenugreek has been shown to control mild diabetes by improving insulin resistance, but it cannot be consumed by persons who are highly allergic to peanuts because of the cross allergy mentioned.

There are other possible cross allergies to legumes like lentils, soy and chickpeas.

Other factors that can cause allergies to get worse

In the past the RAST test was often used.  This is a blood test for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. However, since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test. Children who have food allergies to egg, milk, wheat, nuts, peanuts and soy often outgrow these allergies when they age, in other words their immune system can develop tolerance to many of these foods. Not so with peanut allergies ! They tend to be very persistent.

The immune responses to food allergies are complicated as there are immediate type immune reactions and delayed type immune reactions. The immediate immune responses are investigated with the above mentioned ImmunoCAP Specific IgE test. The delayed immune responses can be measured using the ELISA test. Positive IgE antibody tests for peanut protein are a marker that the person affected likely has more other allergies and they should be investigated by a knowledgeable allergist in that regard (Ref. 2).

What complicates the allergy sufferers’ lives even more is the fact that new wheat varieties since the 1970’s, called Clearfield wheat have a much higher gliadin (gluten) and lectin content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased substantially in the world population (Ref.3). In addition, genetically modified foods like soy, corn, sugar beets, canola and others have challenged the immune system of sensitive humans even more. We do know that some people can develop autoimmune diseases from GMO foods and modern wheat, and this may be the reason that a host of diseases that belong into this disease category (MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis etc.) are much more common now than in the past. The geneticists who developed GMO foods seemed to be unaware how sensitive the immune system is, which will detect a few different amino acid sequences in a protein mounting a strong immune response to it.

Treatment for peanut allergies

The key for sufferers from peanut allergies is to avoid exposure to it. Read labels and use common sense. If something is not labeled, do not be tempted to eat it. Peanut flour is often mixed into the dough of crackers, not being labeled properly or only in fine print. With peanuts the antibodies usually circulate in the blood life long as the B memory cells do not diminish and get reactivated very quickly on repeat exposure producing antibodies again. As exposure to peanuts can cause severe asthma or anaphylactic shock, it is important to carry an EpiPen with you and to know how to use it.

In Europe attempts have been made to develop an oral desensitization method for food allergies including peanut allergies, but it has not produced concrete results yet. Recently, however, research from Texas, USA showed that it is possible to desensitize patients with peanut allergy by oral desensitization. In Australia where food allergies are more prevalent than in the US, tolerance to peanut, nut and shellfish allergies is being pursued by oral immunotherapy. Another group in Australia has developed a vaccination method using peptides, which are a sequence of amino acids, but shorter than the full peanut protein. It appears that this is the future direction of  treatment for peanut and other IgE mediated allergies: a kind of vaccination treatment to induce competing antibodies, which will neutralize the allergic IgE antibodies.

Conclusion

Peanut allergies have become more troublesome as the food industry has mixed peanut flour into Thai sauces, drinks, cookies, crackers and such. The person allergic to peanuts must read food labels and eat as much single-ingredient natural food as possible. This goes against the tendency of food processors who produce foods with a long rat tale of ingredients. If you see a label “may contain nuts or peanuts”, stay away from this product, as it is safer. Always carry an EpiPen or Twinject with you, just in case you develop an anaphylactic reaction (you only have a few minutes to stop the allergic reaction with adrenaline). In the future vaccination with a peanut protein specific peptide vaccine as mentioned regarding the Australian research, will probably become the treatment of choice.

More information on status asthmaticus (an acute asthma attack): http://nethealthbook.com/lung-disease/asthma-introduction/asthma-treatment/

References

1. Adkinson: Middleton’s Allergy: Principles and Practice, 7th ed. Chapter: Food Allergy. © 2008 Mosby.

2. Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed.© 2009 Churchill Livingstone.

3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Apr
14
2013

Allergies Not Only In Spring

Springtime is the time of spring allergies: those affected develop a runny nose, itchy eyes and in more severe cases they may experience a flare-up of asthma. Allergies can be triggered by the increase of pollen counts in the air that occurs every spring. In those who are sensitive, this leads to antibody formation in the blood. But often people have not only sensitivities to the pollens of spring bloomers; they may also be allergic to spores from molds, to dust mites and may have underlying allergies to foods. The immune system has memory cells that memorize that a person has had an allergic encounter to one of these items in the past, and allergic reactions can become more significant with a future encounter. Allergies can also be made worse when a person has food sensitivities and there are cross reactions between pollens of trees or grasses that can share surface protein regions with similar protein regions in foods.

It is known that cross allergies are possible between birch pollen and apple, carrots or hazelnut. In its extreme form allergies due to antibodies, called IgE antibodies, can cause anaphylaxis. A person presensitized by inhaling birch pollen, after eating an apple, hazelnuts or a carrot can develop itching of the throat, swelling of the lips and very quickly deteriorate getting into an anaphylactic shock.

Other cross allergies exist between ragweed pollen, which is a powerful inhalant allergen and melons or bananas. Again there are specific IgE antibodies that are responsible for this immune reaction. In this case the ragweed allergy primes the immune system to produce IgE antibodies, which are potentiated by certain foods that share similar protein components as the ragweed pollen.

In the following I will deal with inhalant allergies separately from food allergies.

Allergies Not Only In Spring

Allergies Not Only In Spring

Inhalant allergies

Inhalant allergies are easier to diagnose and to treat than food allergies. Your doctor will likely refer you to an allergist when you have allergies that do not respond to treatment with intermittent over the counter antihistamines. Your symptoms may come on in the spring with itchy eyes and a runny nose. From year to year you find that you become more and more dependent on antihistamines and nose drops to unplug your nose. The allergist likely will do sensitivity tests, which consist of skin prick or scratch tests on the back or the forearms.

In more serious allergies, where the patient has coughing and wheezing attacks following allergic reactions, the allergist may suggest to start intermittent allergy injections alongside the standard inhalation therapy for asthma. An allergy serum is prescribed where the lab mixes ingredients based on all of the positive tests that led to a strongly positive skin reactions when allergy testing was done. Typically the family doctor or his nurse will start the allergy injections initially in weekly intervals, later when the maintenance dose is reached, it may be modified to injections every 10 to 14 days.

The allergy injections stimulate the immune system to produce harmless competing antibodies, which counteract the disease producing allergic antibodies. In the process of desensitization shots the immune system will normalize, which means that the inflammatory response of the immune system settles down to normal.

This is not the end of the story with inhalant allergies. The patient needs to be retested on a yearly basis by the allergist. The immune system changes all the time as new allergies can develop and old ones may go away.

Retesting is necessary to keep track of what is going on and to change the composition of the allergy serum. Those patients who are working together with the allergist can do very well, and often they gradually outgrow their allergies. Others may not be so lucky. They may have reactions to the allergy injections. In these cases avoidance of what causes the allergy may be the only solution to treat the allergies.

There is an alternative to allergy injections, which has been used in Europe, namely a sublingual immunotherapy. Recently there has been a review of the literature for FDA approval that is needed for oral desensitization for ragweed, dust mites, grass pollen and cat dander. It will take some time before the FDA approval process will become a reality for sublingual desensitization in the US.

A special form of inhalant allergies are allergies to pets (mainly dogs and cats, but also allergies to petting zoo animals). The dander that the human comes in contact with is a protein contained in the animal hair. It causes hives when it touches the skin. This occurs as the dander is absorbed through the skin and meets the local mast cells that release histamine. This in turn is responsible for the hive formation. Sneezing and even asthma can develop from inhaled protein particles that reach the lungs. Allergy injections for the treatment of animal dander allergies are very limited as they often do not help or make the allergies worse. Avoidance of animal contact is usually what the allergist recommends as the solution, a recommendation, which often is not appreciated by the affected animal lover.

Food allergies

Often we eat  some foods more frequently, because they are our favorites. This means that our gut lymphocytes that get in contact with these foods can start to react to one or more of the foods we ingest. At this time we may experience abdominal cramps, diarrhea, vomiting and a host of other possible symptoms.

The physician will tell the patient that testing for food allergies is a problem as most of the usual skin tests employed for inhalant allergies do not reliably work in determining food allergies. The doctor will ask the patient or the mother of the child with food allergies to keep a food diary and keep track of the allergic symptoms in the diary as well. An elimination diet will have to be devised based on the information gathered in the diary as it becomes clear from that record which foods cause which symptoms. The foods causing allergic symptoms are subsequently eliminated. This is a cumbersome process, but it is the most reliable method of testing and treating food allergies.

In the past there was a blood tests, called RAST test, which tested for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. Since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test.

Children often develop food allergies to egg, milk, wheat, nuts, peanuts and soy, which are food allergies with positive IgE tests. When they age, their immune system develops tolerance to many of these foods and they often outgrow these allergies.

There are other popular lab tests where a blood drop is analyzed with IgG, IgM and IgE antibodies against a panel of foods. A number of suppliers offer these tests.  However, the specificity, sensitivity and reliability can pose problems with regard to the interpretation of the results: allergists often point out that a test may be a false positive when a person likes certain foods and IgG antibodies against this food show up despite the patient having no symptoms. Another specialist may interpret this to indicate that the body shows early sensitization to a certain food, but clinically it is not yet obvious. In other words the sensitivity of the test is so high that it undermines the validity of the test. Recently a panel of international scientists reviewed the validity of these IgG based food intolerance tests and they found the tests not reliable.

The immune responses to food allergies are complicated as there are immediate type immune reactions and delayed type immune reactions. The immediate immune responses are investigated with the above mentioned ImmunoCAP Specific IgE test. The delayed immune responses can be measured using the ELISA test.

Other considerations about allergies

You see from this discussion that a patient with allergies needs a properly trained allergist who will do a comprehensive analysis involving a thorough history, examination, blood tests and immune tests.  The test results have to be interpreted with the experience and the clinical judgment of the specialist.

Since the 1970’s when Clearfield wheat was introduced around the world on a large scale, which has a much higher gliadin (gluten) content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased substantially in the world population. Genetically modified foods like soy, corn, sugar beets, canola and more have challenged the immune system of sensitive humans even more to an extent, which is not fully understood yet. We do know that some people can develop autoimmune diseases and this may be the reason that a host of diseases that belong into this disease category (MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis etc.) are much more common now than in the past.

After food elimination for 2 to 12 months depending on the severity of the food allergy, your body may have eliminated the allergy to the food you have avoided, in other words your body built up tolerance. Before you expose yourself to any food that you used to be allergic to and that you want to re-test, it is best to have an EpiPen ready in case your allergy has not resolved. Caution is necessary with regard to foods that cause more severe allergies, e.g. shellfish or peanuts, which may last life long. It is safer to avoid these foods that cause more severe allergies altogether.

Allergic reactions of the immune system belong into the category of chronic inflammatory diseases. These are known to be the root of chronic diseases like asthma, arthritis, heart disease, high blood pressure and cancer. When you are vigilant about allergies and get proper assessment and treatment by an allergist, you will prevent serious health problems including the above mentioned chronic diseases.

More on asthma, which is a chronic inflammatory lung condition, often associated with multiple environmental allergies:

http://nethealthbook.com/lung-disease/asthma-introduction/

Last edited Nov. 6, 2014

Dec
11
2012

What a Wonderful World

Recently I traveled from Palm Springs to the Caribbean and back. There were connecting flights and there was waiting at various airports, so I had lots of time to watch people and to observe what was happening around me.  Louis Armstrong’s song (1967) “What a Wonderful World“ came to mind , and I thought that this would be a fitting title for this Blog. Earlier we had come from Canada escaping the winter. The deep blue sky of Southern California and the sight of palm trees (instead of pine trees) is something that makes our hearts beat faster. The desert is a special place. We had friends join us for a week and we had visited Joshua Tree Park with the grotesque looking rock formations. During the flight it was interesting to see the landscape, as we crossed the desert areas of Arizona and New Mexico, seeing what difference people make when large areas are irrigated and the desert transforms into lush, green areas. It is also very visible, where the desert has taken back the land that no longer is irrigated.

We came to Dallas Fort Worth and the sky was clear. We traveled on to Miami and the sky was showing signs of pollution, although it was a sunny day. After our take-off from Miami we saw the ocean. I have flown over that region many times before, but this time I detected oil slicks on the surface of the ocean of the Gulf of Mexico, leftovers from previous oil spills. So, the Armstrong song of a “wonderful world” came back to me in a different context. I looked at the landscape and what industries can do to it. Erroneously we had just seen several BP commercials while waiting for our plane at the airport where BP was congratulating itself for the role it plays in cleaning up the environment having spent several billion dollars. But there are still oil slicks…

What a Wonderful World

What a Wonderful World

I looked at the people around me in the plane. More than 35% of them were obese; many of their faces looked sagging and prematurely aged, particularly in women. Males, even middle aged ones looked like they were pregnant (abdominal fat) and often their hair was receding, thinning on top and quite a few were bald. All of the texts I had read about anti-aging medicine came back to me. Too bad that people were eating the wrong foods and obviously did nothing to counter their built-in aging clock from depleting hormones as we age. I looked at the menu of the airline (I won’t mention the name of the airline, but I can assure you that 10 different airlines would have almost the same menus), but there would only have been one chicken salad that I could have eaten. In the past I tried to order this and I was told that due to popular demand this item was sold out. Instead they wanted to offer me potato chips, cheese and crackers. My wife and I had anticipated this scenario and we had bought a chicken salad and water before we boarded the plane. We also had packed healthy organic energy bars and a trail mix consisting of nuts and raisins to use as snacks during the trip. While travelling we stuck to the same principal of cutting out starches, bread, rice, pasta and only eating fresh vegetables, salads and lean meat (chicken, grass fed beef, ribs, lean pork and veal), which we always do since the fall of 2001.  We also avoid all alcoholic beverages and sugar containing sodas. When we returned to Southern California we were delighted to see that our body compositions when measured with the body composition scales were identical to what they were before the trip.

I think we can all contribute to this wonderful world, if we participate in whatever we can do such as these steps.

  1. End wars because on the long-term they do not lead anywhere to solve conflicts (in my lifetime I am thinking about the Vietnam war, long-winded Ireland crisis, the Korean war and the German reunification at the end of the Cold War). Right now there is the Middle East conflict, which screams for a peaceful solution. As we are conscious about the devastation that is caused by wars, we have to start with ourselves. We have to resolve our own conflicts that may be present in our own lives. Tolerance, acceptance and forgiveness are the tools.
  2. Pollution needs to be addressed by the US and all of the world’s countries (including Canada where I live most of the time). This means that anti-pollution devices need to be installed in industrial plants and chimneys. Recycling needs to be done on a larger scale. China and India and other emerging market countries need to be taught how these new anti-pollution measures work. This is an ongoing project, but we need more co-operations between government, industry and countries all around the globe. Also we have to start with our own behavior: we can become more aware of reusing and recycling instead of creating more waste in our landfills.
  3. What can we do to make us part of this wonderful world? We need to become better caretakers of our bodies. Instead of looking at quantity we must look at quality in choosing  natural food wherever possible. Growing up in Germany after the Second World War in the 1960’s and early 1970’s made me witness that high consumption of fat, sugar and starchy foods (potatoes, pasta and bread) caused people to age prematurely and get heart attacks, strokes, high blood pressure, arthritis, obesity, diabetes and cancer. At that time the “Wirtschaftswunder” (translated into English it means “economic miracle”) had propelled Germany into a nation of  high consumers. During the war they had been poor and often went hungry, they were slim and heart attacks were at an all-time low. After the war they made up for times of deprivation and overindulged:  pretzels, buns, bread, butter, French fries, sweets, cakes, cookies, jams, chocolates, pralines-everything was consumed with gusto!  What happened to Germany in the 1960’s and 1970’s is happening again right now in front of our eyes with the obesity wave in the US, Canada and all the other civilized countries around the world. Food companies have been very successful with their advertizing through the media. Already kids get hooked to the wrong foods! Hyperinsulinism will ensure that we get hungry every two or three hours. Refined carbs and extra calories are turned into fatty acids by the liver and stored as fat. It shows that we have to resist the wrong food temptation and cut out all refined carbs. It is healthier to stick to salads and vegetables like broccoli, cauliflower, asparagus, and spinach and eat a small piece of lean meat with it. Have probiotics as plain yoghurt (0% to 2% fat). If you need a sweetener, use a small amount of Stevia, which is a natural sweetener that leaves your body chemistry untouched. Have some fruit as a dessert like blueberries, cherries or strawberries. Eat an apple, the occasional grape. Drink lots of purified water or mineral water.
  4. Buy ORGANIC food whenever possible. Most of the vegetables and fruit have been treated with insecticides, which contain residuals in them. When these are ingested, they act like estrogenic substances causing breast cancer in women and prostate cancer in men. The safest in our society is to stick to organic foods. More expensive, but the best insurance against future disease. Question politicians whenever possible to make yourself heard. You want unadulterated food and water. And as I’m writing about water, have a water filter under the kitchen sink with a carbon filter or have reversed osmosis to get rid of chloride or fluoride from the city water. This is what you use to cook your food. You may want to take an iodine tablet once or twice a day to counteract the negative effects of chlorine from having a bath or shower (chlorine gets absorbed through the skin). Why? Because chlorine and fluoride can displace the iodine of the thyroid hormones and make you hypothyroid.
  5. Exercise every day. Nobody gets fit in their muscles from sitting in front of the TV for hours or from spending hours and hours of computer work. If you have to, counterbalance this with an exercise program of 1 hour per day. Walk 30 minutes on a treadmill and do 30 minutes of weights or use specific exercise machines in a gym to strengthen your upper and lower extremity muscles.
  6. Did I mention hormones? Yes, I did above when I mentioned depleting hormones as we age. It is known now for some time that each hormone of the body has its own peak in life and then it declines in production as we age. Or should I rather say, we age when these hormones decline? I like the latter way of wording it, because we can measure hormone levels and when one of the hormones is too low, we can replace it with a bio-identical hormone and the person’s energy comes back and whatever function was missing is restored. This is in essence what anti-aging medicine does. Many conservative physicians and clinics do not like to hear this. Big Pharma does not like to hear this, as I am talking about replacing hormones in the body with bio-identical hormones, not with patented cheap copies that are mass manufactured, sold at inflated prices, but are no fit to the hormone receptors in the body and therefore are dangerous. The artificial drugs cause heart attacks, strokes and cancer as the Women’s Health Initiative has shown in 2002.
  7. What should have been done with the people I watched on the plane? They should have been hormone tested by their physicians. Many of the overweight or obese patients would likely have had high fasting insulin levels. The extra fat does not just sit there; it is a hormone producing factory for inflammatory compounds and estrogen-like substances. This causes heart attacks and strokes in women. It causes prostate cancer and hair loss in males as well as impotence (“erectile dysfunction”). What I said under point 3, 4 and 5 would help these people that I met. When fat is lost through changes in the diet and when an exercise program is started, the body mass index slowly comes down as fat melts away. The estrogen production comes down, the inflammatory substances abate. The person feels more energetic and may even think straighter. One special test is a saliva hormone test that looks at 5 steroid hormones: DHEA-S (storage form of DHEA), testosterone, estradiol, progesterone and cortisol. Every man and every woman needs a certain balance between these hormones and this test should be done when there is a change in energy or appearance (hair loss) somewhere when we are 35 to 40 years. In women it is important that the progesterone level is 200 times fold higher than the estradiol level (progesterone/estradiol ratio) or she is at risk of developing breast cancer and other cancers (ovary, colon etc.). In a man it is important that his testosterone to estradiol ratio is higher than 20 to 1. This protects him from cancer of the prostate or other cancers. Whatever is missing can be prescribed by the physician or a knowledgeable naturopath who is familiar with the use of bio-identical hormone creams. This program can prevent diseases like osteoporosis, diabetes, cancer and arthritis. It also prevents disabilities.

So with a view towards a new year (2013) and with a sense of leaving 2012 behind, I am looking forward to the time when more people can see Louis Armstrong’s vision of a “Wonderful World”.

More information on:

1. Pollution: https://www.askdrray.com/protecting-yourself-from-environmental-toxins/

2. Obesity: https://www.askdrray.com/stop-obesity/

3. Processed food: https://www.askdrray.com/caution-processed-food-ahead/

Last updated Nov. 6, 2014